PTH is an important health problem with a significant impact on long-term outcome of TBI patients. Several risk factors were identified, which can aid in early identification of subjects at risk for PTH.

Background and Purpose-Intracranial arterial stenosis (ICAS) in patients with recent ischemic stroke is associated with a high risk of recurrent stroke. More insight into the pathophysiology of ICAS could help identify patients at high risk requiring more aggressive secondary prevention. We evaluated the prevalence, distribution, calcification, and the risk factors predisposing ICAS in a European stroke population. Methods-Consecutive patients with a transient ischemic attack or ischemic stroke (nϭ786) were evaluated for the presence and distribution of ICAS (Ն30% luminal narrowing) by CT angiography. ICAS were categorized as symptomatic or asymptomatic, and the presence of calcification was assessed. The association of traditional cerebrovascular risk factors and the erythrocyte sedimentation rate with ICAS was analyzed. Results-In 178 of 786 patients (23%), 288 ICAS were observed. Most stenoses (nϭ194/288; 67%) were located in the posterior circulation arteries. In 59 of 786 patients (8%), ICAS were considered symptomatic. ICAS in the basilar artery and arteries beyond the circle of Willis were mainly noncalcified. In addition to age, gender, and several traditional cerebrovascular risk factors, erythrocyte sedimentation rate was independently associated with the presence of ICAS (OR, 1.20; 95% CI, 1.06 -1.36) and with the presence of noncalcified ICAS in particular (OR, 1.20; 95% CI, 1.05-1.37). Conclusions-ICAS

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BackgroundTransient nonfocal neurological symptoms may serve as markers of cardiac dysfunction. We assessed whether serum N‐terminal pro–brain natriuretic peptide (NT‐proBNP) levels, a biomarker of cardiac disease, are increased in patients with transient ischemic attack (TIA) accompanied by nonfocal symptoms and in patients with attacks of nonfocal symptoms (transient neurological attack [TNA]).Methods and ResultsWe included 15 patients with TNA, 69 with TIA accompanied by nonfocal symptoms, 58 with large‐vessel TIA, 32 with cardioembolic TIA, and 46 age‐ and sex‐matched healthy control participants. Serum NT‐proBNP levels were determined within 1 week after the attack. We compared log‐transformed NT‐proBNP levels of patients with cardioembolic TIAs and mixed or nonfocal TNAs, with those of patients with noncardioembolic TIAs as a reference group. Adjustments for age, sex, atrial fibrillation, and a history of nonischemic heart disease were made with a multiple linear regression model. Compared with large‐vessel TIA (mean 14.2 pmol/L), mean NT‐proBNP levels were significantly higher in patients with TIA accompanied by nonfocal symptoms (40.5 pmol/L, P=0.049) and with cardioembolic TIA (123.5 pmol/L; P=0.004) after adjustments for age, sex, atrial fibrillation, and a history of nonischemic heart disease. Patients with TNA also had higher mean NT‐proBNP levels (20.8 pmol/L, P=0.38) than those with large‐vessel TIA, but this difference was not statistically significant.Conclusion NT‐proBNP levels are increased in patients with TIA accompanied by nonfocal symptoms.

Background: Transient ischemic attacks (TIAs) accompanied by nonfocal symptoms are associated with a higher risk of cardiovascular events, in particular cardiac events. Reported frequencies of TIAs accompanied by nonfocal symptoms range from 18 to 53%. We assessed the occurrence of nonfocal symptoms in patients with TIA or minor ischemic stroke in a neurological outpatient clinic in terms of clinical determinants, cardiac history, and atrial fibrillation (AF). Methods: We included 1,265 consecutive patients with TIA or minor stroke who visited the outpatient clinic. During these visits, we systematically asked for nonfocal symptoms. Nonfocal symptoms included decreased consciousness, amnesia, positive visual phenomena, non-rotatory dizziness, and paresthesias. Relative risks for the presence of nonfocal symptoms in relation to clinical determinants, AF, and cardiac history were calculated. Results: In 243 (19%) of 1,265 patients, TIA or minor ischemic stroke was accompanied by one or more nonfocal symptoms. Non-rotatory dizziness, paresthesia, and amnesia were the most common nonfocal symptoms. In patients with an event of the posterior circulation or obesity, the qualifying TIA or minor stroke was more frequently accompanied by nonfocal symptoms, and in patients with significant carotid stenosis, nonfocal symptoms occurred less frequently. AF was related only with amnesia. Conclusion: Nonfocal symptoms are present in one out of 5 patients with TIA or ischemic stroke, in particular when located in the posterior circulation. A cardiac history or AF was not directly related to nonfocal symptoms. A heterogeneous etiology is suggested.

Atrial fibrillation (AF) is a strong risk factor for first-ever stroke and stroke recurrence. The detection rate is low and detection is often costly and time-consuming. We evaluated the diagnostic yield of an external loop recorder (ELR) in patients with acute ischemic stroke or TIA, and assessed factors that are associated with AF detection. We prospectively studied patients admitted to the stroke unit with ischemic stroke or TIA, without a history of AF, and no AF on routine-ECG and 24-h telemetry. Patients received an ELR for another 24-h registration. Rhythm registration with an ELR was performed in 94 patients. AF was identified in 5 patients (5 %). AF was associated with cryptogenic stroke and cortical or subcortical involvement. If ELR was limited to patients with cryptogenic stroke in combination with cortical or subcortical involvement, the detection rate increased to 17 %. Automated recording with ELR was easy to use in the acute setting of ischemic stroke or TIA and seems promising to detect AF or atrial flutter, in particular in patients with cryptogenic stroke in combination with cortical or subcortical symptoms.

1 in which they investigated whether smoking is independently associated with recanalization and better functional outcome in patients treated with tissue-type plasminogen activator. They concluded that smokers had a better response to tissue-type plasminogen activator than nonsmokers. In the past decade, several studies have been published regarding this smoking-thrombolysis paradox.2-7 These studies reveal conflicting results. We performed a meta-analysis of studies that investigated this smoking-thrombolysis paradox.We searched PubMed with combinations of the following terms: outcome, smoking, stroke, and thrombolysis. We selected only studies from which we could extract data for an unadjusted meta-analysis. On the basis of the abstracts, we included relevant studies. References of the included studies were searched to find relevant citation.We collected unadjusted data, such as current smokers, nonsmokers, and modified Rankin Scale scores at 3 months. Favorable functional outcome was defined as modified Rankin Scale score ≤2. Odds ratios were calculated using the MantelHaenszel method with fixed-effect models. The statistical analysis was performed with Review Manager 5.2 (Copenhagen, The Nordic Cochrane Centre, The Cochrane Collaboration, 2011).With our search strategy we found 27 studies, of which 9 were relevant. Three were excluded because data for smokers versus nonsmokers could not be extracted. In total, 7 studies were included, and of these, 4 were in favor of smoking.A total of 7494 patients were included, of whom 2156 (28.8%) were smokers. In total, 4184 patients (55.8%) had a modified Rankin Scale score ≤2 at 3 months, of which 31.7% were smokers. The overall unadjusted odds ratio was 1.38 (95% confidence interval, 1.24-1.53; P=0.02) in favor of smokers.This suggests that smoking is associated with a better functional outcome at 3 months in patients who received tissue-type plasminogen activator. This smoking-thrombolysis paradox also has been seen in patients with myocardial ischemia.This meta-analysis has some limitations. First, the analysis is unadjusted. In earlier studies, there was no better functional outcome in smokers after adjusting for possible confounders. Second, there is a heterogeneous group of data extracted from studies with different inclusion criteria with possible selection bias, various definitions of smoking, and data collection. Third, we split the patient group into current smokers versus nonsmokers. In the non-smokers group, ex-smokers were included because of records of pack-years smoking were not available in all articles. This is a heterogeneous group, unfortunately a specific analysis of pack-years and functional outcome was not possible.In summary, this meta-analysis suggests that smokers who receive tissue-type plasminogen activator with acute stroke had a better functional outcome versus nonsmokers. However, we agree with Kufner et al 1 that smoking is an important risk factor for stroke and that no stroke is always better than a recanalized stroke. DisclosuresNone.

Background and purpose: The rate of newly detected (paroxysmal) atrial fibrillation (AF) during inpatient cardiac telemetry is low. The objective of this study was to evaluate the additional diagnostic yield of an automated detection algorithm for AF on telemetric monitoring compared with routine detection by a stroke unit team in patients with recent ischemic stroke or TIA. Methods: Patients admitted to the stroke unit of Medisch Spectrum Twente with acute ischemic stroke or TIA and no history of AF were prospectively included. All patients had telemetry monitoring, routinely assessed by the stroke unit team. The ST segment and arrhythmia monitoring (ST/ AR) algorithm was active, with deactivated AF alarms. After 24 h the detections were analyzed and compared with routine evaluation. Results: Five hundred and seven patients were included (52.5% male, mean age 70.2 § 12.9 years). Median monitor duration was 24 (interquartile range 22À27) h. In 6 patients (1.2%) routine analysis by the stroke unit team concluded AF. In 24 patients (4.7%), the ST/AR Algorithm suggested AF. Interrater reliability was low (k, 0.388, p < 0.001). Suggested AF by the algorithm turned out to be false positive in 11 patients. In 13 patients (2.6%) AF was correctly diagnosed by the algorithm. None of the cases detected by routine analysis were missed by the algorithm. Conclusions: Automated AF detection during 24-h telemetry in ischemic stroke patients is of additional value to detect paroxysmal AF compared with routine analysis by the stroke unit team alone. Automated detections need to be carefully evaluated.